Screening for Anal Dysplasia and Clinical Follow Up: An Institutional Experience

Summary: Introduction: Although there is evidence supporting the benefit of screening for and treating anal high-grade squamous intraepithelial lesions (HSILs) in persons living with HIV (PLWH) age 35 and older, there is no current consensus on guidelines for anal dysplasia screening. We aimed to evaluate the outcomes of an anal dysplasia screening program at an urban academic safety net hospital. Materials and Methods: The institutional electronic medical reports were searched for all cases of anal Papanicolaou test (APT) performed 2022-2023. The patient's demographics, cytology diagnosis, available surgical specimens diagnoses and clinical follow-up were tabulated. Results: The study included 464 APTs, with samples collected by primary care, infectious disease physicians, and colorectal surgeons. The patients were 433 males (93.3%), 16 females (3.4%), 15 (3.2%) transgender females, ages ranging from 19-75 (mean 37 years), with varying clinical risk factors (Table 1). An elevated rate of APT unsatisfactory cytologic diagnosis was noted (Table 2). Repeat APT, performed in 33 (42%) patients, were negative in 17 (51%) cases, low-grade SIL in 5 (15%), with no high-grade SIL cases detected (Table 2). Of the few cases with simultaneous or follow-up surgical sampling, the results were concordant in 21 (63.6%) cases and showed upgrade to low-grade or high-grade lesions in 5 (15.1%) and 4 (12.3%) cases, respectively (Table 3). A chart review of all clinical follow-up approaches (Table 4) revealed that a subset of patients with abnormal anal cytology who warrant additional evaluation either did not schedule or did not attend a consultation with colorectal surgery. Conclusions: The data from our center highlight opportunities to improve the rate of unsatisfactory APT and understand factors leading to the discordance between cytology and histological results. These findings demonstrate the practical challenges of anal dysplasia screening programs including engaging patients to be screened and serious issues with follow-up and adherence.